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Abstract

Iron deficiency has been suspected to represent one of the possible causes of excessive hair loss in women. The aim of our study was to assess this relationship in a very large population of 5110 women aged between 35 and 60 years. Hair loss was evaluated using a standardized questionnaire sent to all volunteers. The iron status was assessed by a serum ferritin assay carried out in each volunteer. Multivariate analysis allowed us to identify three categories: "absence of hair loss" (43%), "moderate hair loss" (48%) and "excessive hair loss" (9%). Among the women affected by excessive hair loss, a larger proportion of women (59%) had low iron stores (< 40 microg/L) compared to the remainder of the population (48%). Analysis of variance and logistic regression show that a low iron store represents a risk factor for hair loss in non-menopausal women.
... On the other hand, iron supplements were shown to reduce the mean percentage of telogen hair when used for 6 months in women who suffered from chronic Telogen Effluvium 14 Graph 3: Relation between duration of treatment and Improvement low iron stores (ferritin <40 mg/L) was observed in females with androgenic alopecia and alopecia areata comparing to those with normal serum ferritin who didn't suffer from hair fall 15,16 . ...
... Hair loss is one of the major problems in the female population, causing distress and anxiety. This agedependent condition severely affects the patient's quality of life [1]. In developed countries, 25% of the female population suffers from hair loss [2]. ...
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Objective We designed this study to evaluate the association of serum ferritin levels with non-scarring alopecia in women. Methodology All patients were diagnosed by performing a clinical examination of the crown part width and occiput. Ludwig's classification was used to categorize the cases into grades I-III. Different laboratory tests were performed for the baseline investigation, including serum iron, total iron-binding capacity (TIBC), hemogram, and thyroid function tests. Of the 5 ml of venous blood drawn for routine biochemical tests, 3 ml was stored at -20°C for measuring serum ferritin, while the other 2 ml was sent for a complete blood count. Student's t-test, a chi-square test, and Fisher's exact test were used for comparing the variables. Results This study recruited 100 cases of alopecia. Out of them, 46% of patients were diagnosed with alopecia areata, 25% of cases reported androgenetic alopecia, and 29% of cases of telogen effluvium were also observed. We observed overall mean serum ferritin levels of 20.47±17.50 and 27.87±17.51 in the case versus the control group with a statistically significant difference of 0.005. Conclusion Our study shows that iron stores are one of the independent hazards of alopecia in non-menopausal women. Thus, proper laboratory examination is needed to manage the disease prevalence and prognosis.
... We found a significant statistical difference among cases when compared with controls (p= 0.027). Our study found similar results with previous reports, [9,10] which found the association between low iron stores assessed by serum ferritin concentrations and hair loss in women. Several studies have evaluated the relationship between iron deficiency and hair loss; many of them have focussed on women. ...
Article
Objective: Women with diffuse hair loss need to be screened for possible causes or factors responsible for increased hair shedding and also to exclude factors that can increase hair shedding and aggravate the disease. Material and Methods: A prospective cross-sectional study of 40 cases (18–45years) of diffuse hair loss and 40 healthy females were included. The diagnosis was based on the detailed history, clinical examination to rule out pattern hair loss, and hair pull test. Complete hemogram, serum ferritin, vitamin D, and thyroid function tests (T3, T4, thyroid-stimulating hormone [TSH]) along with all routine investigations were determined for each participant. A diet history of vegetarians and non-vegetarians was also taken. Results: On screening, serum ferritin in cases ranged from 3.92 to 104 ng/mL with a mean of 22.36±23.10 ng/mL and that in controls ranged from 5.5 to115 ng/mL with a mean of 29.97±45.72 ng/mL. The serum ferritin level in cases was lower, at a cut-off value of 10 ng/mL, which is statistically significant (p= 0.027). For those with serum ferritin level >10 ng/mL, the mean concentration of hemoglobin was 11.65 ± 0.79 gm%, whereas for the
... We found a significant statistical difference among cases when compared with controls (p= 0.027). Our study found similar results with previous reports, [9,10] which found the association between low iron stores assessed by serum ferritin concentrations and hair loss in women. Several studies have evaluated the relationship between iron deficiency and hair loss; many of them have focussed on women. ...
... Biotin deficiency can manifest as alopecia, brittle nails and dermatitis and low selenium leads to whitened nail beds [5]. Iron deficiency is the world's most common nutritional deficiency and has been shown to be a risk factor for hair loss in non-menopausal women [6] and koilonychia in some cases (spoon-shaped nails) [5]. Although the role of iron in hair loss is not clear, serum ferritin concentration has been shown to be lower in females with patterned hair loss [7] and treatment for hair loss has been shown to be enhanced when iron deficiency, with or without anaemia, is treated [8]. ...
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Deficiency of micronutrients may represent a modifiable risk factor associated with the development, prevention, and treatment of decreased hair and nail quality or hair loss. The aim of this monocentric, single-arm intervention study was therefore to investigate whether taking a food supplement with a rational composition of components affects hair and nail quality in women. A validated and non-invasive tool, the Trichoscale® method, was used to quantify hair loss / hair growth. Subjective evaluation of hair and nail quality was also carried out by subjects and experts using a questionnaire. Intake of the dietary supplement resulted in significant improvement in hair status in several key parameters. The number of hairs in the growth phase significantly increased when compared to baseline (+7.5% after 8 weeks, +10.7% after 16 weeks), as did the density of adult fully pigmented hairs per square centimetre (+2.6% after 8 weeks; +5.9% after 16 weeks). Hair and nail quality improved significantly according to both the self-evaluation of the female participants and the assessment by a dermatological expert. The results of the Trichoscale® method and subjective evaluations consistently demonstrated the beneficial effects of a food supplement on hair growth and nail quality in women.
... Stratification of serum ferritin levels with respect to age, duration of hair loss and weight of patients of androgenic alopecia (Table 2). 11 concluded that in pre-menopausal women having low iron store is a risk factor for hair loss. The lower limit<40 µg/L was taken. ...
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Background: Serum ferritin is a good indicator of quantifying the risk of hair loss among women. Iron lead to low serum ferritin level; therefore, a low serum ferritin level can precisely point toward iron deficiency. Objectives: To determine the mean serum ferritin levels in female patients with androgenetic alopecia. Study Design: Descriptive cross-sectional study Place and Duration of Study: Department of Dermatology, Fauji Foundation Hospital, Rawalpindi from 2nd October 2018 to 1st April 2019. Methodology: One hundred female patients with androgenic alopecia of all ages after puberty were included. Patients with scarring and other non-scarring alopecia, who had taken iron, vitamin B12, folic acid or multivitamin supplements, anticoagulants, anti-thyroid drugs, antimitotic drugs and oral contraceptives were excluded. After aseptic measures,5 ml of venous blood was drawn, into sterile and disposable plastic syringes. Serum ferritin was measured by enzyme immunoassay (EIA) test, based on sandwich ELISA. Results: Mean age was 33.94±6.29 years and 65 (65.0%) of patients ranged from 36 to 50 years. Average duration of disease was 6.25±2.43 months. Mean weight was 58.77±9.17 kg. Mean serum ferritin levels in female patients with androgenetic alopecia was 33.10±42.99ng/ml. Conclusion: Serum ferritin levels in female patients with androgenetic alopecia are low. Keywords: Androgenic alopecia, Serum ferritin levels
Chapter
Iron is a chemical element with the symbol Fe and atomic number 26. It is the most common element on Earth by mass, forming most of Earth’s outer and inner core. Iron is an essential trace element and the most important transition metal found in all living organisms (archaeans, bacteria, and eukaryotes), including humans [1]. Iron is the primary inorganic component of hemoglobin and various other Iron-containing proteins and enzymes, some of which contain heme prosthetic groups, such as cytochrome and catalase [2].
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Objective: To investigate the nutritional habits of the 14-25 years old people with skin problems. Design: We performed a cross-sectional study with random sampling of participants. Skin problems was questioned with questionnaire form. Last three days food consumption was recorded and food consumption frequencies were questioned. Also anthropometric measurements were taken. Setting: A state university and two high school in Samsun, Turkey. Subjects: Students (n =400) aged between 14-25 years. Results: Among students, 251 were women and 149 men. 219 of them have skin problems and 181 didn't have any skin problems. Mean BMI (body mass index) of students was 20.95±2.67 kg/ in women and 22.65±3.17 kg/ in men. Mean body mass index in students with skin problem (SP) was 21.55 ± 2.91 kg/m 2 and without SP was 21.61±3.07 kg/. Among students who have SP problems (n = 219), acne (35.2%) was the first skin problem. Gender, sleep duration, physical activity, frequency of eating out, consumption of tea with food, french fries consumption, daily water intake amount had a significant difference on skin problems (p<0.05). More skin problems were found in individuals eating patisseries (p<0.05). Those who not have skin problems were found to consume more milk, yogurt, buttermilk and mineral water (p<0.05). Conclusions: In this study, it was showed that skin problems could be affected by environmental and personal properties. In order to establish a relationship between these problems and nutrition these properties should be examined. There is not enough research on this subject and another randomized controlled trials are needed to determine the relationship.
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Résumé Objectif: Émettre des recommandations pour la prise en charge des femmes ayant des ménorragies. Conception: Un comité de 26 experts a été constitué. Une politique de déclaration et de suivi des liens d’intérêts a été appliquée et respectée durant tout le processus de réalisation du référentiel. De même, celui-ci n’a bénéficié d’aucun financement provenant d’une entreprise commercialisant un produit de santé (médicament ou dispositif médical). Le comité devait respecter et suivre la méthode GRADE® (Grading of Recommendations Assessment, Development and Evaluation) pour évaluer la qualité des données factuelles sur lesquelles étaient fondées les recommandations. Méthodes: Les dernières recommandations du Collège National des Gynécologues et Obstétriciens Français (CNGOF) sur la prise en charge des femmes ayant des ménorragies ont été publiées en 2008. Nous avons souhaité réactualiser ces recommandations selon la méthodologie GRADE® en identifiant 7 champs différents (diagnostic ; adolescente ; ménorragies idiopathiques ; hyperplasie et polype de l’endomètre ; myomes de type 0 à 2 ; myomes de type 3 et plus ; adénomyose). Chaque question a été formulée selon le format PICO (Patients, Intervention, Comparison, Outcome). L’analyse de la littérature et les recommandations ont été formulées selon la méthodologie GRADE®. Résultats: Le travail de synthèse des experts et l’application de la méthode GRADE ont abouti à 36 recommandations. Parmi les recommandations, 19 ont été établies avec un accord fort et 17 avec un accord faible. Il n’a pas été possible de statuer pour 14 questions pour lesquelles nous avons préféré nous abstenir plutôt que de fournir des avis d’experts. Conclusion: Les 36 recommandations ont permis de préciser les stratégies diagnostiques et thérapeutiques des différentes situations cliniques des plus simples au plus complexes rencontrées par le praticien.
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The iron status of a national sample of adults living in France and participating in the SU.VI.MAX cohort, was assessed using serum ferritin and hemoglobin concentrations. Complete data were obtained for 6648 women 35–60 y old and for 3283 men 45–60 y old. Assessment of iron dietary intakes was realized on a subsample of 3111 women and 2337 men who reported six 24 h dietary records during a one-year period; 22.7% of menstruating women and 5.3% of post-menopausal women presented a total depletion of iron stores (serum ferritin
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One hundred women who presented with diffuse alopecia, were quantitatively evaluated for hair variables and compared with 20 controls. Fifty were selected for biochemical and haematological investigations, 44 of whom also underwent endocrine evaluation. Compared to controls, significant changes in hair values were found in the frontal area of all subjects, while 84% had significant changes in the occipital area. A biphasic distribution of hair diameter was evident in subjects who had percentages of vellus hair and telogen hair less than or equal to 30 mm in length that were above the control ranges. No significant difference between the mean hormonal values of women with diffuse alopecia and controls could be found. No correlation between hair values and individual or combined hormonal levels could be established. In 18 subjects (40.9%) hormonal values were within the control ranges and these apparently normal findings were often associated with adverse hair profiles. A raised dihydrotestosterone was found in 13 subjects (29.5%) and was the most frequently elevated androgenic finding. Seventeen (34.0%) had changes in iron metabolism, while in 36 (72.0%) serum ferritin levels were below the lowest control value. All had a decrease in the percentage of hair in the anagen growth phase compared to controls. The hair changes were similar to those observed in genetic hair loss in men, a proven androgen-dependent condition. We propose that diffuse androgen-dependent alopecia is the appropriate name to describe this condition in these women.
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Hair loss in otherwise healthy women presents several challenges for the clinician. The first is to identify the cause, which may be complicated by two or more secondary factors; the second is to find effective treatments; and the third is to establish requirements for long-term management. An optimal hair growth potential is considered to exist when specific parameters for biochemical variables are operating. These include red blood cell and serum folate concentrations within the normal range, serum vitamin B12 levels between 300 and 1000 ng/L, hemoglobin levels greater than 13.0 g/dL, and serum ferritin concentrations of 70 ng/mL or greater. The two predominant disturbances, diffuse androgen-dependent alopecia and chronic telogen effluvium, both require months of treatment before the benefits can be seen. During this time several follow-up investigations and reassuring consultations must occur. Current systemic antiandrogen regimens are highly effective, but the prospect of long-term therapy, possibly for life, is daunting. For some patients there is no systemic choice and topical treatment is the only option. Minoxidil is the only topical preparation currently licensed, but with no quantitative long-term data available, assessing its value in the long-term treatment of androgen-dependent alopecia is difficult.
Article
Iron status, including serum (S-)ferritin and hemoglobin (Hb), was assessed in a population survey comprising 1359 nonpregnant Danish women in age cohorts of 30, 40, 50, and 60 years. S-ferritin levels were similar in 30- and 40-year-old women; they displayed a significant increase in 50-year-old women and a further significant increase in 60-year-old women. In the 30- and 40-year-old women, median S-ferritin was 38 μg/l, 5-95 percentile 6-135 μg/l; 17.2% had values < 15 μg/l (i.e., depleted iron stores), 22.7% values from 15 to 30 μg/l (i.e., small iron stores), and 60.1% values > 30 μg/l (i.e., replete iron stores). In the 50-year-old women, median S-ferritin was 54 μg/l, 5-95 percentile 10-164 μg/l; 10.3% had values < 15 μg/l, 16.5% values from 15 to 30 μg/l, and 73.2% values > 30 μg/l. For the 60-year-old women, median S-ferritin was 84 μg/l, 5-95 percentile 25-249 μg/l; 1.6% had values < 15 μg/l, 8.6% values from 15 to 30 μg/l, and 89.8% values > 30 μg/l. Blood donors (n = 180) had lower S-ferritin than nondonors in all age-groups (p < 0.001). In the entire series, Hb levels were similar in 30- and 40-year-old women, median 137 g/l (8.5 mmol/l), 5-95 percentile 121-152 g/l (7.5-9.4 mmol/l), and higher in 50- and 60-year-old women, median 140 g/l (8.7 mmol/l), 5-95 percentile 123-158 g/l (7.6-9.8 mmol/l) (p < 0.0001). Hb values < 121 g/l (7.5 mmol/l) were observed in 3.8% of the women. Women with S-ferritin < 15 ug/l (n = 161) had lower Hb, median 134 g/l (8.3 mmol/l), than those with S-ferritin ≥ 15 μg/l, median 139 g/l (8.6 mmol/l) (p < 0.001). Iron deficiency anemia (S-ferritin < 15 μg/l and Hb < 121 g/l) was seen in 2.3% of 30- and 40-year-old women, and in 1.1% of 50- and 60-year-old women.
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Endocrine dysfunction was studied in 109 consecutive female patients with moderate to severe alopecia, mostly of a diffuse pattern. The study included an evaluation of associated hirsutism and/or menstrual dysfunction, plasma hormonal measurements, and ultrasonography of the ovaries. A control group of 24 ovulatory, nonhirsute, nonalopecia individuals was also studied. Of the 109 patients, 70 (64.2%) had no clinical evidence of hirsutism or menstrual dysfunction. Two of 44 patients tested with cosyntropin (Cortrosyn) had 21-hydroxylase deficiency, whereas two other patients had hyperprolactinemia caused by pituitary tumors. Hyperandrogenism was defined as an increase in any of the plasma androgens (testosterone, non-sex hormone-binding globulin bound testosterone, dehydroepiandrosterone sulfate, androstenedione, or dihydrotestosterone) and was noted in 42 of the 109 patients studied (38.5%). Of these 42 patients, 11 were ovulatory with no evidence of clinical hirsutism, 13 were ovulatory and hirsute, and 18 had oligomenorrhea or amenorrhea with or without hirsutism with confirmatory evidence of polycystic ovarian disease. Patients with diffuse alopecia may demonstrate hyperandrogenism, even in the absence of hirsutism, oligomenorrhea, or amenorrhea. The most common endocrine disorder in this series of patients with diffuse alopecia was polycystic ovarian disease.
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Recession of the frontal and frontoparietal hair line in women has been regarded as a marker for pathologic virilization. In a clinical survey of 564 normal women in the population, frontal and frontoparietal recessions were found in 13% of premenopausal and in 37% of postmenopausal women. Patterned hair loss in women is commoner than hitherto described, particularly after the menopause. In the absence of other signs of virilization, "male-pattern" hair loss would therefore appear to be a poor indicator of gross abnormality of androgen metabolism.
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To the Editor.— In view of the articles that have appeared about low iron levels in women with diffuse pattern alopecia (androgenetic alopecia) I thought you would be interested in publishing this letter in the Archives.In a series of 28 women with androgenetic alopecia ranging in age from 20 to post-menopausal, both the serum iron levels and the serum iron binding capacities were normal.It is to be doubted that changes in the hair follicle are related to lack of iron. Rather, androgenetic alopecia may be viewed as the normal response of hair follicle to time and normal hormones.
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The SUpplementation en VItamines et Minéraux AntioXydants (SU.VI.MAX) Study is a randomized, double-blind, placebo-controlled, primary-prevention trial designed to test the efficacy of daily supplementation with antioxidant vitamins (vitamin C, 120 mg; vitamin E, 30 mg; and beta-carotene, 6 mg) and minerals (selenium, 100 microg; and zinc, 20 mg) at nutrition-level doses (one to three times the daily recommended dietary allowances) in reducing several major health problems in industrialized countries, especially the main causes of premature death, cancers and cardiovascular diseases. The present report describes the design, implementation, and baseline characteristics of participants in this 8-year cohort study, which started in 1994 in France; 12,735 eligible subjects (women aged 35-60, and men aged 45-60) were included in 1994 and will be followed for 8 years. Participants undergo a yearly visit consisting, every other year, of either biological sampling or clinical examination. They also regularly provide information on health events and dietary intake by filling out computerized questionnaires using the Minitel Telematic Network. Data on baseline characteristics of the participants suggest that the present sample is close to the national population in terms of geographic density, socioeconomic status, and the distribution of various major risk factors for the diseases under study. The choice of the study population should allow the results of this trial to apply to adult populations of both sexes in France and other industrialized countries.
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Female pattern hair loss is common but estimates of its prevalence have varied widely. The relationships between the clinical diagnosis of female pattern hair loss and objective measurements of hair density and hair diameter have not previously been evaluated. To determine the prevalence of female pattern hair loss and to relate the clinical findings to hair density and hair diameter. We examined 377 women, aged 18--99 years, who presented to a general dermatology clinic with complaints unrelated to hair growth (the unselected sample). A second group of 47 women referred with typical female pattern hair loss was included in analyses of the relationships between hair density, hair diameter and the clinical diagnosis. Hair density was measured using a photographic method. In each subject the major and minor axis diameters were measured in a random sample of 50 hairs. Six per cent of women aged under 50 years were diagnosed as having female pattern hair loss, increasing to 38% in subjects aged 70 years and over. The mean +/- SEM hair density was 293 +/- 61.3 hairs cm(-2) at age 35 years, falling to 211 +/- 55.1 hairs cm(-2) at age 70 years. Hair density showed a normal distribution in the unselected sample. Most women classified as having female pattern hair loss had hair densities within the lower half of the normal distribution. The perception of hair loss was determined mainly by low hair density (ANOVA P < 0.001), but there was overlap in hair density between women classified as having Ludwig I hair loss and the no hair loss group, which was partly accounted for by differences in mean hair diameter (ANOVA P < 0.001). Low hair density was associated with fewer hairs of all diameters. Hair density in women is distributed as a normal variable, indicating that it is determined as a multifactorial trait. Women with female pattern hair loss have a hair density which falls below the mean but lies within the spectrum of the normal distribution, although other factors, including hair diameter, may affect the subjective impression of hair loss. The hair diameter data suggest that low hair density is not due to progressive diminution in hair follicle size and that follicular miniaturization may occur within the space of a single hair cycle.